Program overview :

Integrated Virtual Care Framework for Primary Care

Newfoundland and Labrador Health Services (NLHS) Western Zone

Over the past few years, Newfoundland and Labrador have faced significant challenges with community physician clinic closures, recruitment and retention, and a general shortage of primary care providers. To address these issues, the integration of enhanced virtual care into the existing primary care service delivery model has become essential.

The NLHS Western Zone team designed a new virtual care framework for primary care, incorporating existing frameworks that focus on person and family-centered care, quality improvement and evaluation. This model has successfully increased access to care, expanded service sites and reduced emergency department visits, with 26,000 virtual appointments completed in one year. Enhanced technology and support have been implemented across most sites in the western zone and a hub and spoke model has been established to support more communities.

Objective and purpose of the promising practice 

As Newfoundland and Labrador transition to a single provincial health authority, the province is developing a comprehensive virtual care framework for all zones. In the interim, the Western Zone team created guiding principles featuring an integrated virtual primary care model.

This initiative aims to improve access to primary care and patient experience using virtual care in the Western Zone. The focus is on the appropriate use of virtual care in primary care settings, expanding the Integrated Virtual Primary Care Model to all health neighbourhoods for both attached and unattached patients. This is expected to improve patient outcomes, overall health and wellness, care coordination with team-based shared care and reduce emergency department visits for low acuity issues.

Approach 

Engagement

The project team engaged extensively with diverse clinic staff to co-design new workflows. Through meetings, presentations, reports and weekly check-ins, project deliverables were collaboratively developed and piloted. Key partners included medical leads, clinical nurses, the clinic manager, medical office assistants and a patient navigator. Patient feedback was also collected through surveys and interviews to inform workflow design.

Outcomes

The virtual care model has achieved a regional reach beyond their initial sites of focus through a hub and spoke model, implementing virtual care in 25 of 28 sites, 89% of all primary care sites in the region, including rural and remote communities. All staff in the established Family Care Teams are using the integrated Virtual Primary Care Framework, and long-term plans will see integration of virtual care into all sites. From 1 February 2023 to 31 January 2024, there were 82,912 appointments completed using this model, consisting of 49,284 virtual appointments and 33,628 in-person appointments. Additionally, 26,138 of the appointments were diversions from the Emergency Department1 through the RVCC and virtual locum services, which provided support to unattached patients and cross-coverage for hub and spoke sites within the Zone.

From patient experience surveys, 95% of respondents report being satisfied with their virtual visit (n=38/40) and 93% indicated that their health care needs were met (n=76/79). This project has improved access to primary care services, particularly in rural and remote communities, improved patient and provider experience and reduced overall costs.

Plans are in place for sustaining the improvement, with working groups, clinical care coordinators and managers collaborating to streamline processes, engage partners and transition relevant initiatives into their workloads. Regular meetings and engagement with organizational leaders, family physician partners, and cross-Zone counterparts across the province support their plans to spread the promising practices both regionally and provincially.

Impacts and learnings

Facilitators

• Involvement of patient and provider champions in all aspects of the project.
• Additional members added to family care teams enabled a team-based shared care model.
• Information-sharing through newsletters, huddles, memos, hands-on training, videos and follow-up improved implementation and provider experience.

Barriers

• Staff turnover and hiring delays slowed uptake by some primary care providers, resulting in inconsistent virtual care offerings.
• Public perception and awareness of available virtual care options, such as the misconception that virtual care is only by telephone.

Newfoundland and Labrador have faced significant challenges with physician shortages and clinic closures, prompting the need for enhanced virtual care integration. The NLHS Western Zone team's new virtual care framework, incorporating person and family-centered care, quality improvement and evaluation, has successfully increased access to care, expanded service sites and avoided over 26,000 emergency department visits in one year.

For more information:

Erica Parsons, Regional Director
Medical Services, Rural and PHC Bonne Bay Health Center
ericaparsons@westernhealth.nl.ca